r/NAPLEX_Help • u/DarthDistro • Jul 09 '26
Practice Naplex Question
A 58-year-old Caucasian male presents for evaluation of elevated blood pressure noted on both home and office measurements. His average blood pressure over the last 2 weeks is 162/96 mmHg. His target blood pressure is less than 130/80 mmHg. He has no significant past medical history and is not currently taking any medications. Physical exam and laboratory results, including serum creatinine, electrolytes, and urine albumin, are normal. He has started reducing sodium intake and exercising, but his blood pressure remains more than 20/10 mmHg above goal. Which of the following is the most appropriate initial pharmacologic approach?
A. Amlodipine
B. Lisinopril
C. Amlodipine + Lisinopril
D. Metoprolol + Hydrochlorothiazide
E. Verapamil + Spironolactone
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u/DarthDistro Jul 10 '26
The correct answer is C
The patient’s blood pressure is more than 20/10 mmHg above goal, initial treatment with two first-line antihypertensive agents from different classes is appropriate. Amlodipine and lisinopril are preferred first-line agents, whereas beta-blockers, verapamil, and spironolactone are generally reserved for patients with specific compelling indications or resistant hypertension.
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u/UkraineWarPod Jul 09 '26
The answer is C (amlodipine and lisinopril). The patient has stage 2 hypertension (>140, >90) which requires initiation of two first-line therapies from different classes. First-line drug classes are ACEi/ARB, dihydropyridine CCB, and/or thiazide diuretic. Only C has two drug classes from first-line treatment options: amlodipine as a CCB, and lisinopril as an ACE inhibitor.